'Classic' laparoscopic entry in a university hospital: a series of 8324 cases

Objective To evaluate the complications of 'classic' laparoscopic entry in a university tertiary care centre. Design An analysis of the complications of classic laparoscopic entry for d iagnostic and operative laparoscopies. We considered a consecutive series o f 8324 cases with the same entry technique: CO2 insufflation, followed by i nsertion of the umbilical trocar and subsequent placement of accessory troc ars under direct vizualization. Subjects Between November 1 1992 and December 31 1998, 8324 patients underw ent laparoscopies. The 978 diagnostic laparoscopies (11.75%) and 7346 opera tive laparoscopies (88.25%) were performed by 14 experienced gynaecological surgeons or by trained surgeons under the supervision of one of the experi enced surgeons. Main outcome measures Peri- and postoperative complications of laparoscopic entry were assessed and analysed. Results Laparoscopic entry complications occured in 10 cases out of 8324 la paroscopies (0.12%). These included six vascular injuries, three bowel perf orations and one bladder complication. No death occurred and no blood trans fusions were required. No adverse consequences were observed in five cases. A laparotomy was performed in four cases and in one instance the laparotom y was delayed. Conclusion The complication rate of classic laparoscopic entry was quite lo w in our experience. These results suggest that no modifications to the tec hnique for classic laparoscopic entry are needed.